GRAFT LOSS FOLLOWING LIVER-TRANSPLANTATION IN PATIENTS WITH CHRONIC HEPATITIS-C

Liver disease due to hepatitis C (HCV) is an increasingly frequent ind ication for orthotopic liver transplantation (OLT), The aim of the cur rent study was to analyze the causes of graft loss following OLT for c hronic hepatitis C and the longterm outcome following retransplantatio n in a large university program, Between January 1990 and December 199 5, 1183 patients underwent primary OLT at our center, In 304 patients, HCV was diagnosed by seropositivity and/or polymerase chain reaction, Fifty-six (18.4%) of these patients underwent retransplantation, The 36 patients retransplanted for primary non-function were excluded from further analysis, The other indications for regrafting (>30 days foll owing primary transplant) included hepatic artery thrombosis (5), chro nic rejection (4), severe HCV recurrence (5), and other etiologies (6) . The cumulative survival rates for the 248 patients who received 1 OL T (group 1) were 84% after one year and 75% after three years, The cor responding rates for the 20 non-PNF patients who were retransplanted ( group 2) were 60% and 43%, respectively (P<.0001), Moreover, logistic regression analysis confirmed that patients in group 2 were more than 4 times likely to die than patients in group 1 (P<.0034; risk ratio, 4 .2; 95% confidence interval 1.61 to 11.37). Patients undergoing retran splantation had a high incidence of serious infectious complications l eading to mortality, Two additional patients with severe recurrent HCV died awaiting liver retransplantation, Eight of the 304 total patient s (2.6%) transplanted for chronic HCV developed graft failure secondar y to HCV recurrence and 6 of the 8 were retransplanted; 3 of the 6 pat ients retransplanted are alive without evidence of histologic recurren ce (mean follow-up less than 1 year), In summary, despite the high fre quency of recurrent histologic evidence of HCV following primary OLT ( 70% at 3 years), graft loss attributable solely to HCV is an infrequen t finding, Retransplantation per se is a risk factor for a fatal outco me, and the indication for reOLT does not appear to impact ultimate ou tcome, Serious infectious complications were the leading cause of mort ality in patients retransplanted, Furthermore, given the indolent natu ral history of HCV, longer follow-up is necessary to determine the ult imate rate of graft loss due to HCV recurrence.